Open Reduction and Internal Fixation (ORIF) of the ankle is a surgical procedure used to treat ankle fractures that are displaced, unstable, involve the joint surface, or cannot heal properly with casting alone. These injuries often occur after falls, sports injuries, or high-energy trauma and can affect one or more of the bones that form the ankle joint, including the tibia, fibula, or both. Before surgery, the patient undergoes a thorough evaluation that includes physical examination and imaging such as X-rays or CT scans to determine the exact fracture pattern and joint involvement. The care team reviews swelling, skin condition, circulation, and overall health to ensure the ankle is ready for surgery. In some cases, surgery may be delayed briefly to allow swelling to decrease, during which time the ankle is immobilized in a splint. The procedure is performed under regional or general anesthesia. During surgery, the surgeon makes incisions over the ankle to directly access the fractured bones. This allows the bone fragments to be carefully repositioned into their normal anatomical alignment, known as open reduction. Once aligned, internal fixation is performed using metal plates, screws, or rods to hold the bones securely in place and restore stability to the ankle joint. Accurate alignment is critical to preserving joint function and reducing the risk of long-term complications such as arthritis. After surgery, the ankle is typically placed in a splint or cast, and patients usually go home the same day or after a short hospital stay. Pain and swelling are common initially and are managed with medications, elevation, and limited activity. Weight-bearing is usually restricted, and patients may need crutches, a walker, or a knee scooter for mobility. Recovery progresses in stages. Early healing focuses on protecting the repair and allowing the bones to fuse properly. As healing advances, the cast or boot may be removed, and physical therapy begins to restore range of motion, strength, and balance. Gradual weight-bearing is introduced based on healing progress and follow-up imaging. Full recovery can take several months, depending on fracture severity and patient factors. Ankle ORIF aims to restore joint alignment, stability, and function, allowing patients to safely return to daily activities, work, and, eventually, sports when appropriate.